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Use of Sub-National Indicators to Improve Public Health in Europe Dr Lorraine Stewart Principal Public Health Specialist 4 March 2010

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Rationale of Project Many indicators sets such as ENHIS, ECHIM, and ECHI are available to enable national assessment of the health status of a population Policies and interventions which deliver positive outcome(s) nationally may not be effective within some sub-populations Given this, this consortium felt there was a need to develop a harmonised environmental health information system of sub-national indicators to complement the national indicators set.

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Aim Context: Within the framework of Work Plan 2008 for the implementation of the Second Programme for Community Action in the field of Public Health (2008- 2013), this project aims to develop a sustainable environmental health monitoring system consisting of a set of sub-national/regional indicators to improve public health across Europe and facilitate the comparability of health status and data and identify policies and interventions that deliver positive health outcomes

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Specific Objectives 1.To develop a core set of sub-national environment and health indicators 2.To develop a system for harmonised health information collection 3.To examine the feasibility of harmonised data collection for indicators not fully developed by ENHIS, if appropriate 4.To raise awareness and promote participation 5.To produce a compendium of policies and interventions 6.To develop a methodology for regional comparison

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Progress to Date  Selection of core set of indicators  Development of methodological sheets  Data collation for core set of indicators  Identification of new indicators  Development of Database

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1.Life expectancy at birth 2.Infant mortality rate 3. Annual mortality rate due to respiratory diseases in children older than one month and under one year of age 4.Mortality due to respiratory diseases 5.Mortality due to diseases of the circulatory system 6.Death rate per 100,000 population for road traffic injuries 7. Cause-specific death rates per 100,000 population for unintentional injuries not related to traffic accidents 8. Mortality due to external causes in children under 5 years of age 9.Injury rate due to traffic accidents per 100,000 population Core Set of Indicators MORTALITY, INJURY

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10. Number of outbreaks of waterborne diseases attributable to drinking water and bathing water each year; number of cases in the outbreaks 11. Number of outbreaks of communicable diseases attributable transmitted by food per year; number of cases in the outbreaks 12. Incidence rate of acute intestinal communicable diseases and bacterial food toxic infections 13. Incidence of leukaemia (ICD-10: C90-C95) in children aged 0 to 19 years 14. Incidence of melanoma (ICD-10: C43, D03) in the population aged under 55 years Core Set of Indicators OUTBREAKS, INCIDENCE

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15.15. Proportion of identified bathing waters falling under the Bathing Water Directive definition complying with the EC mandatory standards 16.16.Drinking water quality: microbiological non-compliance 17.17.Drinking water quality: chemical non-compliance 18.18. Population-weighted annual mean particulate matter (PM 10 ) concentration 19.19. Proportion of population in urban areas exposed to PM 10, NO 2, SO 2, O 3 concentration exceeding limit values 20. Proportion of population living in dwellings that are exposed to certain values of noise from different sources in urban areas and along major transport infrastructures 21.21.Unemployment 22.22.Living floor area per person Core Set of Indicators ENVIRONMENT, SOCIO-ECONOMIC STATUS

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Methodological Sheet Template Name of indicator DPSEEA CEHAPE Regional Priority Goal CategoryGroup the indicator according to the overarching issue Justification for this indicatorDescribe the importance of the indicator in terms of the priorities of environmental health considering the magnitude, the severity, the amenability, and public concerns of the problem Definition of indicatorProvide a detailed technical definition of the indicator Underlying definitions and conceptsDefine all terms used in describing and constructing the indicator Specification of data neededList the data needed to construct the indicator Data sources, availability and qualityState the sources of data. Where appropriate, indicate methods of obtaining data that are not readily available. ComputationProvide detailed technical guidance for the calculation of the indicator Units of measurementSpecify the units of measurements used in presenting this indicator

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Name of indicator DPSEEA CEHAPE Regional Priority Goal Scale of applicationWith relevance to sub-national levels: Local (within a city or community) and regional (within a sub-national region) InterpretationDescribe the ways the indicator may be interpreted and related to the issue(s) specified in the category section. Highlight inferences which can be made from any trends or patterns observed in data analyses Linkage with other indicatorsLinkage with other indicators from the core set of UNIPHE project Related data, indicator sets and websites List similar or related indicators, proposed or developed as part of other indicator sets. Give links to their sources e.g. web addresses, databases. Provide any evidence base which is available Policy/ regulatory contextTo be completed later within the WP8 Reporting obligationsDescribe obligations (national or sub- national legislations or constitutions) which exist with regards to the reporting of any data used in the computation of the indicator. Where applicable, include quantitative targets on reporting the data.